Simultaneous repair of chronic full-thickness rotator cuff tears during fixation of proximal humerus fractures and clinical results

Abstract

Objectives: We investigated the incidence of chronic rotator cuff tears encountered during fixation of proximal humerus fractures with locking plate-screw systems, and evaluated the functional results of simultaneous surgical repair of these injuries. Methods: A total of 111 patients underwent surgical treatment for proximal humerus fractures. Of these, nine patients (8 females, I male; mean age 73 years; range 56 to 84 years) who had concomitant chronic full-thickness rotator cuff tears were included in the study. According to the AO classification, the fractures were type 11A1 (12C1 also present) in one patient, 11A2 (12C2 also present) in one patient, 11B1 in two patients, 11B2 in three patients, and 11C2 in two patients. None of the patients underwent preoperative magnetic resonance imaging. Fracture fixation was made with the PHILOS plate in five patients, and with the S3 Proximal Humerus Plate in four patients. All full-thickness rotator cuff tears were detected during the operation. Following open reduction and internal fixation after a deltoid splitting incision, rotator cuff tears were repaired by primary suture in two patients, and with a suture anchor in seven patients. All the patients used a padded shoulder-arm sling for six weeks and received a standard rehabilitation program. All the patients were evaluated radiographically and functionally using the Constant-Murley shoulder score at postoperative 6 weeks, 6 months, and 12 months. The mean follow-up period was 17.3 months (range 8 to 30 months). Results: The incidence of full-thickness rotator cuff tears was 8.1%. All the patients had supraspinatus tears, which were accompanied by infraspinatus tears in three patients. The sizes of the tears were classified as large (between 3-5 cm) in three patients, intermediate (between 1-3 cm) in five patients, and small (<1 cm) in one patient. One patient had L-shaped, two patients had U-shaped, and six patients had C-shaped tears. None of the patients had healing problems or avascular necrosis. The mean Constant-Murley shoulder score was 85.4 (range 67 to 100). All the patients were satisfied with the results of surgical treatment. Conclusion: The integrity of the rotator cuff must be checked after reduction and fixation of proximal humerus fractures and., when present, the tears should be repaired simultaneously either primarily or with suture anchors. Simultaneous repair of rotator cuff tears does not negatively affect functional outcomes.